For over 30 years, First Choice Health has offered Medical Management services to coordinate the delivery of the best care for our members—helping optimize patient outcomes while managing healthcare costs.
From specialized case management programs to review of provider billing practices via claims review, our Medical Management team provides a portfolio of services to enable-cost saving strategies for our clients and members. We also provide actionable predictive modeling data that identifies trends and helps our clients more effectively address the health of their workforce.
We work with our providers and members to ensure the highest quality of care
FCH Medical Management strives to improve the health outcomes of our members through a variety of care management and data analysis tools. These tools assist in identification of specific members within the population who may benefit from a targeted clinical approach. We offer a range of well-organized and effective services for the well to critically ill.
Our expert staff and predictive modeling tools identify patterns and trends where clinical intervention with a patient’s provider can result in an improved outcome and/or more cost-effective care. Interventions are carefully targeted and clinically relevant, ensuring respect and support from participating providers. The Medical Management team also identifies and addresses potential care gaps, and reviews all inpatient admissions on a daily basis.
Behavioral Health Coordinated Care
Our Utilization Management team actively collaborates with community providers to ensure patient safety, optimize the health of our members, and enable cost-saving strategies wherever possible. Services include inpatient and outpatient pre-authorization, inpatient admission review, discharge planning, and other coordination of services.
Our Case Managers work closely with benefit managers, program administrators, families, and providers to coordinate delivery of high quality, medically necessary services. Specific patient-centered programs, such as Bariatric Services, Transgender Services, CarePath, Emergency Department Utilization, and Chronic Pain and Opioid Use Disorder, are also available.
Behavioral Health Coordinated Care
The Behavioral Health Coordinated Care program provides case management for selected mental health diagnosis, and facilitation and coordination of outpatient and inpatient care for mental health and chemical dependency.
The COPE Program (Chronic Opioid Pain and Education) was developed by the Medical Management team to address the current health crisis, and bring our extensive clinical knowledge and resources to support a healthy workforce population for our clients. The two parts of the program include data analysis and identification, and member outreach. More Information
Claims processed by First Choice Health that require clinical interpretation are reviewed by the Medical Management Claims Review team. This group brings clinical and coding expertise to provide research, support, and clinical insight into complex and high dollar claims. Claims Review also supports retrospective clinical reviews, appeals, stop loss, perceived fraud and abuse, and reconsideration issues.
Other Medical Management Services
Other services include clinical appeals, provider reconsideration, health promotion services, pharmacy benefit management, stop loss coordination, subrogation, and more.
Personalized, Quality Service
We believe customer service is the most important thing we do and we make every effort to exceed our clients' expectations
Flexible, Customized Solutions
We collaborate with our clients in new and innovative ways. Let’s work together to build the best solution for your company.
Experienced Clinical Team
Our team of healthcare experts includes Medical and Behavioral Health Physicians (MDs), Registered Nurses, and master’s level Behavioral Health Clinicians.
We provide insightful analysis and actionable reporting to identify trends so our clients can more effectively address the health of their workforce.